超纯透析液对血液透析患者促红细胞生成素抵抗的影响  

Effect of ultrapure dialysate on erythropoietin resistance in hemodialysis patients

作　　者：王尊松[1] 张瑞凤[2] 许冬梅[1] 崔美玉[1] 

机构地区：[1]山东大学附属千佛山医院肾内科,济南250014 [2]内蒙古自治区包头市中心医院肾内科,内蒙古包头014040

出　　处：《山东大学学报（医学版）》2010年第12期90-93,共4页Journal of Shandong University:Health Sciences

摘　　要：目的探讨超纯透析液对维持性血液透析患者促红细胞生成素(EPO)抵抗的影响。方法选择维持性血液透析患者70例,随机分为普通透析液组和超纯透析液组,每组35例,评价影响患者促红细胞生成素抵抗指数(ERI)的相关因素,观察透析1年后两组超敏C反应蛋白(hs-CRP)和ERI的差异。结果 ERI分别与hs-CRP呈显著正相关(r=0.432,P<0.01),与血清白蛋白呈负相关(r=-0.359,P<0.05),与甲状旁腺激素(iPTH)呈正相关(r=0.316,P<0.05),与标准化蛋白代谢分解率(nPCR)呈负相关(r=-0.307,P<0.05);以ERI为因变量进行多元逐步线性回归分析显示,hs-CRP是ERI的独立影响因素(R2=0.699,P<0.001);随访1年后两组间hs-CRP含量差异有统计学意义[(5.12±2.74)mg/Lvs(3.77±2.19)mg/L,P<0.05],超纯透析液组ERI有明显改善(1.10±0.53vs1.64±0.71,P<0.01)。结论 hs-CRP、血清白蛋白、nPCR和iPTH是影响维持性血液透析患者EPO抵抗的相关因素;hs-CRP升高是促红细胞生成素抵抗的独立影响因素;使用超纯透析液可改善血液透析患者炎症状态和促红细胞生成素抵抗。Objective To explore the effect of ultrapure dialysate on erythropoietin（EPO）resistance in patients on maintenance hemodialysis.Methods 70 patients taking regular hemodialysis were randomly divided into two groups：the conventional dialysate group（n=35）and the ultrapure dialysate group（n=35）.All the patients had been on hemodialysis for more than 3 months and on the EPO treatment for more than 3 months.EPO dosage was titrated to maintain a target hemoglobin（Hb）level between 110 g/L and 120 g/L.EPO resistance index（ERI）was calculated as weekly EPO dose/kg weight/g Hb.Laboratory tests including the general examination of blood,biochemistry test of blood,serum ferritin,hypersensitive C reactive protein（hs-CRP）and intact parathyroid hormone（iPTH）were detected in each patient.The relationship between ERI and laboratory factors mentioned above was analyzed.And after 12-month treatment,differences of hs-CRP and ERI were analyzed between the two groups.Results Correlation analysis showed that ERI had a statistically significant correlation with CRP（r=0.432,P〈0.01）,serum albumin（r =-0.359,P〈0.05）,iPTH（r=0.316,P〈0.05）and nPCR（r =-0.307,P〈0.05）.hs-CRP was the most important independent predictor of ERI（R2=0.699,P〈0.001）by multiple linear stepwise regression analysis.After 12-month treatment,there were marked differences in hs-CRP and ERI between the conventional dialysate group and the ultrapure dialysate group（5.12±2.74 vs 3.77±2.19,P〈0.05 and 1.64±0.71 vs 1.10±0.53,P〈0.01,respectively）.Conclusions CRP,serum albumin,iPTH and nPCR are factors related to ERI.hs-CRP is the most important independent predictor of ERI.Use of ultrapure dialysate should be beneficial to the inflammation status and ERI in long-term hemodialysis patients.

关 键 词：超纯透析液 血液透析 促红细胞生成素 促红细胞生成素抵抗 

分 类 号：R459.5[医药卫生—治疗学]